| NPI | 1407269541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 284025) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301114258) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2024-05-20 |